Showing posts with label Respiratory. Show all posts

A male client abruptly sits up in bed, reports having difficulty breathing and has an arterial oxygen saturation of 88%.. Non-rebreather mask

A male client abruptly sits up in bed, reports having difficulty breathing and has an arterial oxygen saturation of 88%.

Which mode of oxygen delivery would most likely reverse the manifestations?

A. Simple mask
B. Non-rebreather mask
C. Face tent
D. Nasal cannula

Based on the presented scenario, the most likely mode of oxygen delivery to reverse the manifestations of the male client would be: B. Non-rebreather mask.

Here's why:

- The client's condition is severe:

With an arterial oxygen saturation of 88%, the client is experiencing moderate to severe hypoxemia, requiring prompt intervention.

- Simple mask and face tent offer lower FiO2 (fraction of inspired oxygen):

While both can deliver supplemental oxygen, they typically offer a maximum FiO2 of around 40-50%, which may not be sufficient for this client's needs.

-Nasal cannulae offer even lower FiO2:

Their maximum FiO2 is around 28-40%, making them inadequate for addressing moderate to severe hypoxemia.

- Non-rebreather mask delivers higher FiO2:

A non-rebreather mask can deliver up to 90% FiO2, providing a higher concentration of oxygen compared to other options. It also has a reservoir bag that reduces rebreathing of exhaled CO2, improving oxygen delivery further.

Therefore, considering the seriousness of the client's hypoxemia and the need for a higher FiO2, a non-rebreather mask is the most appropriate choice for this specific situation.

It's important to note that this is a general recommendation based on the limited information provided. The actual treatment should be determined by a qualified healthcare professional who can assess the patient's full clinical picture and provide the most appropriate care.

Nurse Eve formulates a nursing diagnosis of Activity intolerance related to inadequate oxygenation and dyspnea for a client with chronic bronchitis.

To minimize this problem, the nurse instructs the client to avoid conditions that increase oxygen demands. Such conditions include:

a- drinking more than 1,500 ml of fluid daily.
b- being overweight.
c- eating a high-protein snack at bedtime.
d- eating more than three large meals a day.

Answer B.

Conditions that increase oxygen demands include obesity, smoking, exposure to temperature extremes, and stress.
A client with chronic bronchitis should drink at least 2,000 ml of fluid daily to thin mucus secretions; restricting fluid intake may be harmful.
The nurse should encourage the client to eat a high-protein snack at bedtime because protein digestion produces an amino acid with sedating effects that may ease the insomnia associated with chronic bronchitis.
Eating more than three large meals a day may cause fullness, making breathing uncomfortable and difficult; however, it doesn’t increase oxygen demands.
To help maintain adequate nutritional intake, the client with chronic bronchitis should eat small, frequent meals (up to six a day).

The most likely condition to avoid to minimize oxygen demands for a client with chronic bronchitis is: b. being overweight.

Here's why the other options are less likely to be problematic:

a. Drinking more than 1,500 ml of fluid daily:

Adequate hydration is crucial for lung function, especially for someone with chronic bronchitis. Increased fluids can help thin secretions and make them easier to expel, improving breathing.

c. Eating a high-protein snack at bedtime:

Protein intake is essential for overall health and muscle maintenance, which can indirectly help with respiratory effort. A small high-protein snack is unlikely to significantly impact oxygen demands.

d. Eating more than three large meals a day:

While large meals can temporarily increase metabolic rate and oxygen demand, this is usually a transient effect. Eating smaller, more frequent meals might be more comfortable for someone with chronic bronchitis, but it wouldn't significantly reduce oxygen needs.

Disadvantages:

However, being overweight carries several disadvantages for people with chronic bronchitis:

Increased work of breathing: Excess weight puts additional strain on the diaphragm and other respiratory muscles, making it harder to breathe, especially during exertion.
Reduced lung capacity: Fat tissue can compress the lungs, further limiting lung function and oxygen intake.
Decreased oxygen diffusion: Excess body fat can decrease the efficiency of oxygen transfer from the lungs to the bloodstream.
Therefore, managing weight is an important strategy for improving oxygenation and reducing dyspnea in individuals with chronic bronchitis. Nurse Eve's advice to avoid being overweight is sound and aligns with evidence-based management practices for this condition.

Remember, this is just one aspect of managing chronic bronchitis. A comprehensive approach involving medication, lifestyle modifications (including weight management), and pulmonary rehabilitation is often necessary for optimal outcomes.

The physician is going to remove the chest tube from a client. The nurse should least likely prepare which of the following item?

a. Sterile gauze
b. Suture removal kit
c. Empty bottles
d. Adhesive tape

The least likely item the nurse should prepare for chest tube removal is: c. Empty bottles

Here's why:

- Sterile gauze:

Sterile gauze is often used to apply pressure at the insertion site after the tube is removed to help control any bleeding.

- Suture removal kit:

Depending on how the chest tube was secured, the nurse may need to remove sutures as part of the removal process.

- Adhesive tape:

Adhesive tape may be needed to secure the dressing applied after tube removal.

- Empty bottles:

While it's important to have empty drainage bottles on hand as a backup, typically the chest tube drainage system is already in place and connected to empty bottles. Replacing the bottles during removal is not a usual step.

Therefore, considering the typical steps involved in chest tube removal, empty bottles are the least likely item the nurse would need to prepare beforehand.

However, it's important to note that specific preparation may vary depending on the institution's protocol and the individual patient's situation. Always refer to the physician's orders and your practice's guidelines for definitive instructions.

A slightly obese female client with a history of allergy-induced asthma, hypertension, and mitral valve prolapse is admitted to an acute care facility for elective surgery.

The nurse obtains a complete history and performs a thorough physical examination, paying special attention to the cardiovascular and respiratory systems. When percussing the client’s chest wall, the nurse expects to elicit:

a. Resonant sounds.
b. Hyperresonant sounds.
c. Dull sounds.
d. Flat sounds.

Answer A.

When percussing the chest wall, the nurse expects to elicit resonant sounds — low-pitched, hollow sounds heard over normal lung tissue. Hyperresonant sounds indicate increased air in the lungs or pleural space; they’re louder and lower pitched than resonant sounds. Although hyperresonant sounds occur in such disorders as emphysema and pneumothorax, they may be normal in children and very thin adults. Dull sounds, normally heard only over the liver and heart, may occur over dense lung tissue, such as from consolidation or a tumor. Dull sounds are thudlike and of medium pitch. Flat sounds, soft and high-pitched, are heard over airless tissue and can be replicated by percussing the thigh or a bony structure.

The correct answer is a. Resonant sounds.

Percussion is a physical examination technique used to assess the underlying density of organs or tissues. Resonant sounds are produced when percussing over air-filled structures like the lungs. In this case, the client has a history of asthma, which can affect the lungs' ability to expand and contract effectively. However, the client is not experiencing any acute respiratory distress, and the nurse should expect to hear resonant sounds when percussing over the chest wall.

Option b, Hyperresonant sounds:

is characterized by an abnormally loud, hollow sound produced when percussing over an air-filled structure. This could be indicative of hyperinflation, which is a condition where the lungs are overinflated due to air trapping. While hyperinflation can be associated with asthma, it is not typically present in a stable client with controlled asthma.

Option c, Dull sounds:

are produced when percussing over solid structures like the liver or heart. In this case, the nurse is specifically percussing over the lungs, which are air-filled structures, so dull sounds would not be expected.

Option d, Flat sounds:

are produced when percussing over fluid-filled structures or consolidated lung tissue. Consolidation occurs when the alveoli, the air sacs in the lungs, become filled with fluid or inflammatory cells. While consolidation can be a complication of asthma, it is not typically present in a stable client with controlled asthma.

Therefore, the nurse expects to elicit resonant sounds when percussing the client's chest wall.

A black client with asthma seeks emergency care for acute respiratory distress.

Because of this client’s dark skin, the nurse should assess for cyanosis by inspecting the:

a. Lips.
b. Mucous membranes.
c. Nail beds.
d. Earlobes.

Answer B.

Skin color doesn’t affect the mucous membranes. The lips, nail beds, and earlobes are less reliable indicators of cyanosis because they’re affected by skin color.

A female client with chronic obstructive pulmonary disease (COPD) takes anhydrous theophylline, 200 mg P.O. every 8 hours.

During a routine clinic visit, the client asks the nurse how the drug works. What is the mechanism of action of anhydrous theophylline in treating a nonreversible obstructive airway disease such as COPD?

A. It makes the central respiratory center more sensitive to carbon dioxide and stimulates the respiratory drive.
B. It inhibits the enzyme phosphodiesterase, decreasing degradation of cyclic adenosine monophosphate, a bronchodilator.
C. It stimulates adenosine receptors, causing bronchodilation.
D. It alters diaphragm movement, increasing chest expansion and enhancing the lung’s capacity for gas exchange.

Answer A.

Anhydrous theophylline and other methylxanthine agents make the central respiratory center more sensitive to CO2 and stimulate the respiratory drive. Inhibition of phosphodiesterase is the drug’s mechanism of action in treating asthma and other reversible obstructive airway diseases — not COPD. Methylxanthine agents inhibit rather than stimulate adenosine receptors. Although these agents reduce diaphragmatic fatigue in clients with chronic bronchitis or emphysema, they don’t alter diaphragm movement to increase chest expansion and enhance gas exchange.

A female client must take streptomycin for tuberculosis. Before therapy begins, the nurse should instruct the client to notify the physician if which health concern occurs?

a. Impaired color discrimination
b. Increased urinary frequency
c. Decreased hearing acuity
d. Increased appetite

Answer C.

Decreased hearing acuity indicates ototoxicity, a serious adverse effect of streptomycin therapy. The client should notify the physician immediately if it occurs so that streptomycin can be discontinued and an alternative drug can be prescribed. The other options aren’t associated with streptomycin. Impaired color discrimination indicates color blindness; increased urinary frequency and increased appetite accompany diabetes mellitus.

A female client is undergoing a complete physical examination as a requirement for college.. Chest movements

A female client is undergoing a complete physical examination as a requirement for college.

When checking the client’s respiratory status, the nurse observes respiratory excursion to help assess:

a- Lung vibrations.
b- Vocal sounds.
c- Breath sounds.
d- Chest movements.

Answer D.
The nurse observes respiratory excursion to help assess chest movements.

Normally, thoracic expansion is symmetrical; unequal expansion may indicate pleural effusion, atelectasis, pulmonary embolus, or a rib or sternum fracture.

The nurse assesses vocal sounds to evaluate air flow when checking for tactile fremitus; after asking the client to say "99," the nurse palpates the vibrations transmitted from the bronchopulmonary system along the solid surfaces of the chest wall to the nurse’s palms.

The nurse assesses breath sounds during auscultation.

Bronchodilators include the following apart from.. Dipenhydramine

Bronchodilators include the following apart from:

a- Theophyline

b- Terbutaline

c- Metaproterenol

d- Dipenhydramine

Answer: D.

Benadryl (Dipenhydramine) is an antihistamine not bronchodilator.

Presence of overdistended and non-functional alveoli is a condition called.. Emphysema

Presence of overdistended and non-functional alveoli is a condition called:

a- Bronchitis

b- Emphysema

c- Empyema

d- Atelectasis

Answer: B.
An overdistended and non-functional alveoli is a condition called emphysema.
Atelectasis is the collapse of a part or the whole lung.
Empyema is the presence of pus in the lung.

After thoracentesis the client should be placed on which position.. Supine position

After thoracentesis the client should be placed on which position?

a- Affected side

b- Unaffected side

c- Prone position

d- Supine position.

Answer: D.
After thoracentesis the client is placed or turned to the unaffected side to prevent leakage of fluid in the thoracic cavity.

The nurse in charge is teaching a client with emphysema how to perform pursed-lip breathing.. It helps prevent early airway collapse

The nurse in charge is teaching a client with emphysema how to perform pursed-lip breathing.

The client asks the nurse to explain the purpose of this breathing technique.
Which explanation should the nurse provide?

a- It helps prevent early airway collapse.

b- It increases inspiratory muscle strength.

c- It decreases use of accessory breathing muscles.

d- It prolongs the inspiratory phase of respiration.

Answer A.
Pursed-lip breathing helps prevent early airway collapse.
Learning this technique helps the client control respiration during periods of excitement, anxiety, exercise, and respiratory distress.
To increase inspiratory muscle strength and endurance, the client may need to learn inspiratory resistive breathing.
To decrease accessory muscle use and thus reduce the work of breathing, the client may need to learn diaphragmatic (abdominal) breathing.
In pursed-lip breathing, the client mimics a normal inspiratory-expiratory (I:E) ratio of 1:2. (A client with emphysema may have an I:E ratio as high as 1:4.)

Pulmonary disease (COPD), which nursing action best promotes adequate gas exchange.. Using a high-flow Venturi mask to deliver oxygen as prescribed

Pulmonary disease (COPD), which nursing action best promotes adequate gas exchange?
a- Encouraging the client to drink three glasses of fluid daily

b- Keeping the client in semi-Fowler’s position
c- Using a high-flow Venturi mask to deliver oxygen as prescribed
d- Administering a sedative as prescribed.

Answer C.
The client with COPD retains carbon dioxide, which inhibits stimulation of breathing by the medullary center in the brain. As a result, low oxygen levels in the blood stimulate respiration, and administering unspecified, unmonitored amounts of oxygen may depress ventilation. To promote adequate gas exchange, the nurse should use a Venturi mask to deliver a specified, controlled amount of oxygen consistently and accurately. Drinking three glasses of fluid daily wouldn’t affect gas exchange or be sufficient to liquefy secretions, which are common in COPD. Clients with COPD and respiratory distress should be placed in high Fowler’s position and shouldn’t receive sedatives or other drugs that may further depress the respiratory center.

After undergoing a thoracotomy, a male client is receiving epidural analgesia.. Respiratory depression

After undergoing a thoracotomy, a male client is receiving epidural analgesia. Which assessment finding indicates that the client has developed the most serious complication of epidural analgesia?
a. Heightened alertness
b. Increased heart rate
c. Numbness and tingling of the extremities
d. Respiratory depression

Answer D.
Respiratory depression is the most serious complication of epidural analgesia. Other potential complications include hypotension, decreased sensation and movement of the extremities, allergic reactions, and urine retention. Typically, epidural analgesia causes central nervous system depression (indicated by drowsiness) as well as a decreased heart rate and blood pressure.

The client is immediately given oxygen by face mask and methylprednisolone (Depo-medrol) I.V.. Albuterol - Proventil

At 11 p.m., a male client is admitted to the emergency department. He has a respiratory rate of 44 breaths/minute. He’s anxious, and wheezes are audible. The client is immediately given oxygen by face mask and methylprednisolone (Depo-medrol) I.V. At 11:30 p.m., the client’s arterial blood oxygen saturation is 86% and he’s still wheezing. The nurse should plan to administer:
a. Alprazolam (Xanax).
b. Propranolol (Inderal)
c. Morphine.
d. Albuterol (Proventil).

Answer D.
The client is hypoxemic because of bronchoconstriction as evidenced by wheezes and a subnormal arterial oxygen saturation level. The client’s greatest need is bronchodilation, which can be accomplished by administering bronchodilators. Albuterol is a beta2 adrenergic agonist, which causes dilation of the bronchioles. It’s given by nebulization or metered-dose inhalation and may be given as often as every 30 to 60 minutes until relief is accomplished. Alprazolam is an anxiolytic and central nervous system depressant, which could suppress the client’s breathing. Propranolol is contraindicated in a client who’s wheezing because it’s a beta2 adrenergic antagonist. Morphine is a respiratory center depressant and is contraindicated in this situation.

A male client admitted to an acute care facility with pneumonia is receiving supplemental oxygen, 2 L/minute via nasal cannula.. Apnea

A male client admitted to an acute care facility with pneumonia is receiving supplemental oxygen, 2 L/minute via nasal cannula. The client’s history includes chronic obstructive pulmonary disease (COPD) and coronary artery disease. Because of these history findings, the nurse closely monitors the oxygen flow and the client’s respiratory status. Which complication may arise if the client receives a high oxygen concentration?
a. Apnea
b. Anginal pain
c. Respiratory alkalosis
d. Metabolic acidosis

Answer A.
Hypoxia is the main breathing stimulus for a client with COPD. Excessive oxygen administration may lead to apnea by removing that stimulus. Anginal pain results from a reduced myocardial oxygen supply. A client with COPD may have anginal pain from generalized vasoconstriction secondary to hypoxia; however, administering oxygen at any concentration dilates blood vessels, easing anginal pain. Respiratory alkalosis results from alveolar hyperventilation, not excessive oxygen administration. In a client with COPD, high oxygen concentrations decrease the ventilatory drive, leading to respiratory acidosis, not alkalosis. High oxygen concentrations don’t cause metabolic acidosis.

A client with Guillain-Barré syndrome develops respiratory acidosis as a result of reduced alveolar ventilation

A client with Guillain-Barré syndrome develops respiratory acidosis as a result of reduced alveolar ventilation. Which combination of arterial blood gas (ABG) values confirms respiratory acidosis?
a. pH, 5.0; PaCO2 30 mm Hg
b. pH, 7.40; PaCO2 35 mm Hg
c. pH, 7.35; PaCO2 40 mm Hg
d. pH, 7.25; PaCO2 50 mm Hg

Answer D.
In respiratory acidosis, ABG analysis reveals an arterial pH below 7.35 and partial pressure of arterial carbon dioxide (PaCO2) above 45 mm Hg. Therefore, the combination of a pH value of 7.25 and a PaCO2 value of 50 mm Hg confirms respiratory acidosis. A pH value of 5.0 with a PaCO2 value of 30 mm Hg indicates respiratory alkalosis. Options B and C represent normal ABG values, reflecting normal gas exchange in the lungs.

A male client with pneumococcal pneumonia is admitted to an acute care facility. The client in the next room is being treated for mycoplasmal pneumonia.. Inflamed lung tissue

A male client with pneumococcal pneumonia is admitted to an acute care facility. The client in the next room is being treated for mycoplasmal pneumonia. Despite the different causes of the various types of pneumonia, all of them share which feature?
a. Inflamed lung tissue
b. Sudden onset
c. Responsiveness to penicillin.
d. Elevated white blood cell (WBC) count

Answer A.
The common feature of all types of pneumonia is an inflammatory pulmonary response to the offending organism or agent. Although most types of pneumonia have a sudden onset, a few (such as anaerobic bacterial pneumonia and mycoplasmal pneumonia) have an insidious onset. Antibiotic therapy is the primary treatment for most types of pneumonia; however, the antibiotic must be specific for the causative agent, which may not be responsive to penicillin. A few types of pneumonia, such as viral pneumonia, aren’t treated with antibiotics. Although pneumonia usually causes an elevated WBC count, some types, such as mycoplasmal pneumonia, don’t.

A male client suffers adult respiratory distress syndrome as a consequence of shock.. Kinking of the ventilator tubing

A male client suffers adult respiratory distress syndrome as a consequence of shock. The client’s condition deteriorates rapidly, and endotracheal (ET) intubation and mechanical ventilation are initiated. When the high-pressure alarm on the mechanical ventilator sounds, the nurse starts to check for the cause. Which condition triggers the high-pressure alarm?
a. Kinking of the ventilator tubing
b. A disconnected ventilator tube
c. An ET cuff leak
d. A change in the oxygen concentration without resetting the oxygen level alarm

Answer A.
Conditions that trigger the high-pressure alarm include kinking of the ventilator tubing, bronchospasm or pulmonary embolus, mucus plugging, water in the tube, coughing or biting on the ET tube, and the client’s being out of breathing rhythm with the ventilator. A disconnected ventilator tube or an ET cuff leak would trigger the low-pressure alarm. Changing the oxygen concentration without resetting the oxygen level alarm would trigger the oxygen alarm.

After receiving an oral dose of codeine for an intractable cough.. In 30 minutes

After receiving an oral dose of codeine for an intractable cough, the male client asks the nurse, “How long will it take for this drug to work?” How should the nurse respond?
a. In 30 minutes
b. In 1 hour
c. In 2.5 hours
d. In 4 hours

Answer A.
Codeine’s onset of action is 30 minutes. Its peak concentration occurs in about 1 hour; its half-life, in 2.5 hours; and its duration of action is 4 to 6 hours.